A new
report from the Institute of Medicine (IOM) proposes a framework to
assess the value of community-based, nonclinical prevention policies and
wellness strategies, especially those targeting the prevention of long-term,
chronic diseases.

The
report's authors conclude that a comprehensive framework for valuing
community-based prevention programs and poli­cies should meet 3 major criteria. First, the framework should
account for ben­efits and harms in physical and mental health, community
well-being, and community process. The physical and mental health domain
includes reductions in the incidence and prevalence of dis­ease, declines in
mortality, and increases in health-related quality of life.

Second,
the framework should consider the resources used and compare the benefits and
harms associated with those resources. To effec­tively compare interventions,
it is essential to quantify the magnitude of benefits in relation to the
associated cost for each intervention.

Third,
the framework must take into account differ­ences among communities that can
affect the link between interventions and outcomes.

Because
selecting 1 community-based prevention pol­icy or program over another can be
difficult, the report recommends that decision
makers weigh the ben­efits and harms to health, community well-being, and
community process as they assign value to specific interventions.

The authors caution that although a community-based preven­tion
action may improve the overall health of a community, it may achieve more
strikingly positive results among citizens with a certain income level or
occupation, exacerbating health disparities. If achieving health equity is at
odds with improving overall community health, priorities will have to be
determined, they say.